Scholar Finds Tools to Cut Risk of Developmental Delays in Foster Children

A pediatrician identifies more effective methods for physicians and caregivers to help prevent developmental and emotional problems in toddlers and teens in foster care.

Children who grow up in foster homes often face a long list of daunting obstacles. “Many have experienced abuse or neglect and have not been raised in a nurturing and supportive environment,” said Robert Wood Johnson Foundation Physician Faculty Scholar (2007-2010), Sandra Jee, M.D., M.P.H. With her most recent research and another study to be published later this year, Jee explains that she and her colleagues are “building a new health model for children in foster care, focusing on reducing children’s risk of developmental delays and mental health problems by providing comprehensive services in a pediatric medical home,” Jee said.

Her study, “Improved Detection of Developmental Delays among Young Children in Foster Care,” published in the February 2010 issue of the journal, Pediatrics, proved the effectiveness of using a questionnaire to assess children in foster care, ages 4 months to 5 years.

“The American Academy of Pediatrics recommends doing developmental screening for young children using standardized screening instruments,” Jee notes, “but busy practitioners often do not use them, relying on their own informal assessments and caregiver reports instead. We used that method with a baseline group, then administered the Ages and Stages questionnaire to the study group. We were able to identify more than double the number [28 percent in the baseline group, 59 percent in the screening group] of children at risk for problems with communication, movement, problem solving, personal and social development when we used the standardized instrument,” Jee said. “Identifying potential developmental problems in young children and helping them to get timely access to services can produce the best possible long-term outcomes.”

Jee, an assistant professor of pediatrics at the University of Rochester Medical Center, completed her first study after beginning her Physician Faculty Scholar term and is spending her time in the program examining developmental problems among young children and adolescents. “Our upcoming papers will report on using standardized instruments to assess social and emotional disorders in adolescents in foster care,” Jee said. “We found that getting input from both adolescents and their foster parents by using questionnaires completed in the physician’s office produced the most comprehensive results.”

Having physicians assess adolescents is also less stressful for teens. “In my own practice at the Starlight Clinic in Monroe, N.Y., where we see all of the children in foster care in the county, I’ve found that many teens feel it is less stigmatizing if they can discuss their psychosocial concerns at their doctor’s office, rather than at a traditional mental health facility,” Jee said. “Figuring out ways to provide services is challenging because many of these teens have lived years with untreated problems and opportunities for them to get psychological services are limited. We are working on providing services in a way that is innovative and appealing to teens who may need help, but are reluctant to access traditional mental health services.”

In her previous research, Jee looked at the chronic health problems of children in foster care, but her focus shifted as the world of pediatrics began to change. “We now see many, many kids with social and emotional issues,” she explains. By confirming the value of standardized, in-office screening, Jee hopes to make it possible for pediatric medical homes to provide more comprehensive services and support to children in foster care and their caregivers.

“As an outgrowth of my study findings, I am working on training foster parents to deal with these problems at home and adding resources to our offices to expand our services to children,” Jee said.

The Robert Wood Johnson Foundation Physician Faculty Scholars Program was created to strengthen the presence of generalist physician faculty in the nation's medical schools. Scholars—who are junior faculty in family medicine, general internal medicine and general pediatrics—are given four-year career development grants to explore areas of health services research.